Operating urethroscope



June 19, 1923.

S. REISLER ET AL OPERATING URETHROSCOPE 1921 2 sheets-sheet Filed Juhe'2a nritll M/zzesses:

June 19, 1923.

S. REISLER ET AL OPERATING URE'THROSCOPE Filed June 28, 1921 2Sheets-Sheet 2 5 n a e 2 C 4 1 Inventor Wt/zesses @W gww mam 6% PatentedJune 19, 1923.

'' uniren s'rares PATENT OFFICE.-

PHILADELPHIA,

PENNSYLVANIA.

OPERATING 'URETHROSCOPE.

Application filed June 28, 1921. Serial No. 481,030.

1 0 all to 1mm it may concern Be it known that we, Dr. SIMON REIsLER andHEnRMAN-N B. ToBIAs, citizens of the United States of America, andresidents,.respectively, of the city of Indianapolis, in the county ofMarion and State of Indiana, and of the city of Philadelphia, in thecounty of Philadelphia and State of Pennsylvania, have invented a newand Improved Operating Urethroscope, and do hereby declare the following"to be a full clear, and exact description of the same. reference beinghad to the accompanying drawings, forming a part of the specifications,and to the reference numbers marked thereon.

0111' present invention relates to an instrument intended for thesurgical treatment of the anterior urethra.

The main object of the invention is to provide an instrument tofacilitate the surgical technique introduced by Dr. Simon Reisler forthe cure of chronic anterior urethritis.

A further object of the invention is to provide an instrument that canbe easily operated and also used as an endoscope aero-. scope or withattachments as a cystosc ope.

The attachments mentioned above will form the basis of futureapplications.

For the purpose of illustration the instrument is shown toa veryexaggerated scale while in actual practice the circumference of thecross section is only 26 millimeters.

In carrying out our invention, we provide a main tube having a topwindow along most of its length and a telescoping tube having a shorterwindow, both tubes being open at the rear end; the telescoping tubehaving at the front end devices for propelling through the tubesilluminating, res fleeting. focusing, operating. irrigating andaspirating tools, all as will be hereinafter more fully described, themain features being pointed out in the appended claims. 1

Figure 1 shows an isometric perspective view of the instrument withmainelements line 22 of Figure .6.

Figure 3 shows a vertical section through the front end of theinstrument taken on line 3-3 of Figures 4 and 5.

Figure 4 shows a view ofthe front end of the instrument and its relationto the telescoping tube taken on line t4 of Figure 3, having thereflecting mirror and its carrier removed.

Figure 5 is a section through the instrument taken on line 55 of Figure3.

Figure 6 shows a cross section through the rear end of the instrumenttaken on line 66' of Figure 2.

Figure 7 is a vertical section along the long axis ofthe main tube withthe obturator in position to facilitate'its introduction in the urethra.

Figure '8 is a vertical section along the long axis of'the Folliculotometaken on lines 8 of Figures 9 and 10.

Figure 9 is a cross-section to the operating end of the Folliculotometaken on line 9 of Figure. 8 and showing the operating knife. i

Figure 10 a cross section through th body of the Folliculotome taken .online 10 of Figure-8.

' Figure 11 is a top view of the instrument elongated to approximate therelative pros portion between parts,

Figure 12- is a vertical section along the long axis of the instrumentas shown by Figure 11, having the front reflecting mirror and carrierremoved. c

Figure 13 is a cross section through the main tube and obturator takenon line 13 of Figure 7.

Figure 14 is a cross section. thru the telescopihg tubes in theircircular form instead of the ovoid. form shown elsewhere for the presentillustration.

F igure- 15 is a cross section thru the secondar'y' tube taken on line15--15 of Fig.

3, showing the anchoring chair with the light carrier removed.

i The instrument constructed in accordance with our invention embodiesamain tube 15, formed of very thin section and for the presentillustration of an ovoid form.

The front end of the tube 15 is made in tegral with ashiel 1.6 throughthe flange 1.7.

The rear end is cut away as shown at 18 to permit endoscopic operations.

The top of the main tube is provided with an opening or window 19throughout most of its length to permit folliculotomie operations at anypoint of the urethra.

A secondary tube 20 is PIOVlClBCl to snugly fit and telescopeinto themain tube 15. The rear end of the secondary tube is cut away as shown at21 to permit endoscopic operations. The top part of opening 21 isextended longitudinally as shown at 22 to form a parabolic cut for thepurpose hereinatter. described.

" by springlock pins 26.

and s0 are provided to secure t'h An anchoringchair 27 is providedintegral with the lower front end of secondary tube 20, having anopening 28 thru which the light carrier is passed.

T he top flange of this chair is curved and is provided with side wings'29 so arranged as not to interfere with the optical system ofltheinstrument providing a top rest for the minor in'strun'ients oranchoring orifices 30 on either side of light carrier opening 28. frontend of the funnel is provided with a' reino-vablecover 31 secured inplace by pin 32, tongue 33 and pivoted side clips 34, the jointbeingsealed by a suitable gas ket.

The top of the cover 31 is extended at 35 and provided with side stopsintended to receive and support a. reflecting mirror frame, hereinafterdescribed.

Integral with the front cover 31, is a tube 37 open at both ends andflanged at 38 to hold a lens. Snugly fitting inner sleeves v p e lenses4 1 and 42 at a proper spacing. f

An opening 43 is provided in the front cover to admit the lightcarrierminto the tubes.

Below opening 43 and on either side thereof large openings 44 and 45 areprovided covered by removable plugs {i6 and 47.

These plugs have eccentric holes 481m admitting); tool. into the tubesand may be used separately or be a slidable part of the various toolsused.

Some of these plugs have no holes intended to render instrument tightagainst air or liquids, while other plugs are provided with valvedoutlets to facilitate the introduction into the instrument or extractiontherefrom are pivoted to the flanges 51 and 52 of the mirror frame byrivets 58. Depressions 59 are provided in the flanges56 and 57 of themirror plate flanges intended to press against flanges'51 and 52 of themirror frame and thereby hold said mirror at any desired angle.

The mirror carrier can also be made in- I tegral with the sleeve 40omitting in such case the lip 50 and thereby permitting the radialadjustment of the mirror. I

A light carrier 60 is provided having a standard electric connectionplug 61 at the front end and a reduced section 62 at the rear end. e

As is usual. in these light carriers the center rod 63 carries oneelectric current form while the outer shell 64k carries the otherelectric current torin being separated by the insulating; tube 65. s

.The circuit is closed by. the lamp 66 screwed through a plug 67 intothe rear end of light'carrier. i

The base 68 of the lamp .isas large as the main tube of light carrierforming thereby a stop tor the reduced section 62 of the lightcarriertube. Z

A rear reflecting mirror 69 provided mounted on a mirror plate 70 andheld in place by tongues 71.

l lan'e'es 72 are provided integral with mirror plate thru whichsupporting pivot pin TS'is passed and secured to the mirror carrierframe 74, 1

Flanges 75 with holes 76 are provided at the front side of mirror plateintended to facilitate the tilting oi the mirror by the use of asuitable hook and hold the mirror at any desired angle by the frictionof said flanges against the wall of the inner tube 20 orof the mirrorcarrier 74.

The mirror carrier istorined to fit snugly The obtui'ator shown inFigure'7 is made to fit snugly in the main tube l5,'having a pointed end '79to facilitate introduction into the urethra, a reduced section 80 ofsufficient width to cover the top window,19 and a handle 81. I Theoperating tool with which this'improved urethroscope is vitally linkedis as named for the present purpose the Folliculotome.

The Folliculotome. of a very small cross section is shown in Figures 1and 8 as formed of a tube 82, the front end of which is provided with afinger loop handle 88 or other suitable gripping device- The rear oroperating end of the Folliculoton'ie is cut away for a suitable disWhile we have shown the instrument hav-- iug an ovoid cross section oftubes'it can also be made of a round cross section as shown in Figure14, all other parts'and functions remaining the same. 1

The operation of this instrument with the above description in view willbe readily understood. The medical operating technique requiring thisinstrument is the splitting of the follicle or lacunae without injuringthe adjacent uretheal mucosa, in cases of chronic anterior urethritis,removing thereby the inflammatory process in the mucuous glands, theglands of littre and the lacunae of Morgagni. This operation isperformed by the knife 8 beiug moved toward the end 83 after said endlibeen introduced into the follicle. The action of theknife is: securedby the pressure of knob 86 againstthe spring- 87 and grip ring 88 andtransmitting sai'dlongitudinal motion, to the knife through rod Thisknife is operated through windows 19 and of the urethroscope orth-roughthe end windows 18 and 21. 0

Preliminary to this operation the instrument is introduced into theurethra by the aid if the obturator in Figure 7 which is afterwardsremoved leaving the main tube in position.

The secondary tube 20 is then introduced into the main tube 15, with thereflecting parts in position, including light carrier 60. rear mirror69, front mirror 53 and. focusing lenses 4L1 and 42.

The rear mirror 69 can be moved longitudinally by sliding light carrierback and forth the required distance to place both light and mirror inrequired position,

The rear mirror 69 can. be tilted to, any

desired angle icy-introducing a Wire hookthrough frontopening 4st andengaging holes 76 ofmi-rror plate, moving back and forth asrequired. v

The'rear mirror may thus be laid flat as shown by dotted lines at 100and thereby offer a clear endoscopic view 'allowing at the same time thesliding of the lamp 566 nearer the end of the tube and under the mirrorplate.- The rear refle'ctingmirror is'prefer ably of a slightly convexform to secure a small reduction" of the membranes under observation.

The lenses 41 and 4-2 are of suchfocal caliber as to receive and correctthe-"reflection presented by the rear mirror. 5 The front reflectingmirror is preferably of a slightly concave form tosecure a smallenlargement o1 the projection from the lenses 42 and 4:1.

When a direct'view is desired through they instrument thefront'reflecting mirror may be lowered against the light carrier rod or.

it can be removed entirely with its supporting frame.

'VVhen desired, the front cover or funnel can be entirely removedand-the operating tools can then be handled through the open front end.7

The Folliculotome is introduced-into the tubes through the opening 47and hole 4-8 of plug it is then pa'ssedlu'nder the flange 29 of chair 27and thereby secures two supporting points to'steadyit. In certaininstances the omission of thisnchair would be desirable. I 1 Its angularposition re-lative to the axis of the tubes or the field of operationcan be varied bythe radial rotation of plug '45.-

Through the plug 44:: additional instru-. ments or tools can beintroduced such as,

aeroscopic dilating tube, canulas 'for irri- I gating or aspirating,filliforms or probes, galvanic needles applicators or flu-id and? solidmedicinal agents. i i I .For cystoscopic examinations "orgtre'atr mentthe inner. tube 20 is elongated-by an attachment (the basisof a future.application) and is pushedbackits-full. length'and passed through theend 18 of main tube 1 5.

By reversing the inner tube or by turning the entire instrument aroundandadjusting.

its mirror lateral observations orthe examination and treatmentof vitalparts such asurethral openings" through the capaciou's vices,a'folliculotome and-other means for aeroscop'ic aIIClGDCl OSCQPICpurposes thereby COIUHEgWItlHI'L the scope ofour principleand inventionI Having thus described our invention, What We claim anddesire to'secureby Letters Pat- 'ent, is: 1. In an instrument of the characterdescribed, the combination WithtWo telescopingzurethroscopic tubeshaving-rear end WllF doWs; an operating front; and an adjustableilluminated optical system for reflecting the field of operation to theoperator at right angles to the axis of tlieinstruments, of a longlateral WVlIlCiOW in both tubes and a Folliculotome operatingthrough'said I lateral WlTlClO-WS. i

'2; In an instrument ofthe character cescribed, the combination of twotelescoping tubes open :at the front :and rear ends and bothPI'OVldEiClWlth long lateral Windows; a

' Folliculotomeoperating through said lat eral Windows; 'airilluminatedoptical sys tem for reflecting the field of operation r0 'tlie -operatorat right angles to the axisof the instrument and means for adjustingtheilluminated optical system and for sealing the instrumenttofacilitate aeroscopic and endoscopic operations. i 3. In an instrumentof the character described, the combination of a main tubeand asecondary telescoping tube, both provided With end and long lateralWindows; niech an-ism at the front of the'secondary tube for admittinginstruments thereto an adjustable illuminated optical system for the indirect reflection and observation of the field of operation; and aFolliculotome, operat ingythrough said lateral WlIlClOWS and com:prising a tube With a guiding groove at one end; a sliding knife Withinsaid guiding groove and aspring cont-rolled operating mechanism at theopposite end extending through said tube to slide said knife relative tothe end of said guiding groove.

4. In an instrunient'of the character de "ments therein and for sealingsaid tube for aeroscopicoperatioii; and an optical system Within theinner tube comprising a slidable light carrier; a slidable rearreflecting mirror controlled by said light carrier; mechanism forsupporting and varying the angle of said rear mirror; a plurality oflenses at the front end of the inner tube for receiving and correctingthe image from rear mirror.

and a front reflecting mirror mounted on a removable frame, havingmechanism for' varying the angle of said mirror relative to the axis ofthe optical system to facilitate indirect observation of'the field ofoperation;

scribed, the combination of a main tube and a secondary tube, bothprovidedwith end and long lateral windows; a Folliculotomel operatingthrough said lateral Windows; an adjustable illuminated optical systemforthe indirectreflection and observation of'the field of operation; aprotecting shield at the front end of main tube, and operating mechanismat the front end. of thesecondary tube comprising a removable funnel;With means forfsecuring it to secondary tube; a removable frontcoverlwith means for securing it to the large'end ofsaid funnel; meansupon said front cover for supporting i and securing the plurality oflenses of the optical system and the front reflecting mirror;perforations in said cover for admitting to the inner tube the lightcarrierand operatin instruments and *plugsffor covering saidperforation, having eccentric bores for supporting operating instrumentandfor' controlling theirangle relative to long axis of inner tube bytheir rotation in said perforaoptical mechanism at the front-end oftele-' scoping. tube for absorbing,

I correcting and indirectly pro ecting the image from rear reflector;mechanism at front end of telescoping tubefor admittinginstruments'there to and sealing said tube for aeroscopic operation; andlong lateral Windows provided in both tubes having their ends ofparabolic form to prevent injury to the membrane of urethra duringtheirtelescoping action; and a Folliculotome extending through said longlateral Windows for splitting the inflamed follicle or lacunae in theurethra.

In testimony whereof We have signed our names to this specification inthe presence of two subscribing witnesses.

, SIMON REISLER, M. D. Witnesses:

JOHN K. Bunenss, P. F. THRUSH. v V HER-MANN 'B. TOBIAS. vWitnesses: I i

EDW. N. VoLnnR,

B. M. AUCHTER;

5; In an instrument ofthe character de-

